Duck J Kim MD PC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

110604 Issued in NY

Legal business name

DUCK J KIM MD PC

Practice address

210 Cornelia St
Ste 204
Plattsburgh, NY 12901-2396

Phone

(518) 563-8050

Fax

(518) 563-8352

NPI assigned

Aug 15, 2006

Reactivated

Mar 9, 2011

Last updated

Mar 9, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Duck J Kim, MDNPI 1386858694

Title

Owner

Phone

(518) 563-8050

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Duck J Kim, MD

  • Otolaryngology Physician
  • Plattsburgh, NY
  • NPI 1386858694
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299628800000",
    "number": "1194738500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 CORNELIA ST",
            "address_2": "STE 204",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129012396",
            "telephone_number": "518-563-8050",
            "fax_number": "518-563-8352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 CORNELIA ST",
            "address_2": "STE 204",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129012396",
            "telephone_number": "518-563-8050",
            "fax_number": "518-563-8352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUCK J KIM MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2011-03-09",
        "deactivation_date": "2007-12-17",
        "reactivation_date": "2011-03-09",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "DUCK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-563-8050",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "110604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00511922",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD NORTHEASTERN",
            "identifier": "000405443001",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawn Dubay, LPN, RN
• Steve Dubay, DC
• Sunu Dubay, NP
• Janya Lee Dubrey, LMSW
• Isabelle Duchesnay, M.D.
• Jarren Daniel Dudden
• Beth Ann Dumas, M.A., CCC-SLP
• Jessica Dunn-Williams
• Danny Douglas Dupree, LMSW
• Erica Danielle Dupree, PHARM D

• Otolaryngology Physician in Plattsburgh, NY
• Providers in Plattsburgh, NY by specialty
• Otolaryngology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.